Provider Demographics
NPI:1245262856
Name:MCCLAIN, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 NW 28TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1717
Mailing Address - Country:US
Mailing Address - Phone:954-218-0180
Mailing Address - Fax:
Practice Address - Street 1:1749 NE 26TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1428
Practice Address - Country:US
Practice Address - Phone:954-218-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422435207LP2900X
FLME107651207LP2900X
FLME0107651207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00170079200003Medicaid
FL004333000Medicaid
FL004333000Medicaid
PA020939Medicare ID - Type UnspecifiedMCRE
PAH01958Medicare UPIN